Locate the internal-appeal decision and deadlines
HHSC’s client FAQ distinguishes agency appeals from MCO cases after the internal appeal has been completed. Keep the original service decision, your internal-appeal submission and the resulting decision together. Ask your plan which document contains the current hearing instructions if the sequence is unclear.
The official guidance describes a 120-day hearing-request period after the MCO internal appeal. Use the date and instructions on your actual notice. Asking to continue services can involve a separate, shorter deadline and possible repayment if the hearing is unsuccessful; ask the plan to explain those requirements immediately.
Sources: HHSC fair-hearing questions for clients; Parkland STAR member appeals and state fair-hearing instructions
Submit the hearing request through the stated route
Follow the plan’s hearing-request instructions and keep confirmation. For example, Parkland’s STAR member page provides a State Fair Hearing and External Medical Review Request Form plus plan contact routes. Members of another plan should use that plan’s notice and contact details.
If someone will represent you, ask how the plan and hearing office record that arrangement. Name the task you need help with: submitting the request, receiving notices or participating in the hearing. A separate clinical information release does not settle the hearing office’s requirements.
Sources: Parkland STAR member appeals and state fair-hearing instructions; HHSC fair-hearing questions for clients
Distinguish external review from hearing evidence
External medical review is an optional additional review before the state fair hearing. HHSC’s STAR Kids handbook describes an independent organization reviewing the internal-appeal record. It does not consider new information submitted for that external review.
The hearing process is different. Parkland’s member guidance explains that new facts may be submitted to HHSC for the hearing and shared with the plan. Follow the hearing notice for sending documents. Ask which process a document belongs to before assuming one upload serves both reviews.
Sources: HHSC STAR Kids handbook: external medical review; Parkland STAR member appeals and state fair-hearing instructions
Prepare the hearing connection and assistance
HHSC says most hearings take place by telephone and the appellant calls the number and access code in the hearing notice. Put that notice, the plan’s evidence and your submitted materials where you can find them during the call.
Request an interpreter or accommodation early through the hearing process. If you need another date, contact the hearing office promptly; a reschedule request does not change the appointment until the office confirms it. Keep the original date on your calendar while the request is unresolved.
Your next-step checklist
- Find the MCO internal-appeal decision.
- Record the hearing and any continuation-of-services deadlines separately.
- Use the request route in your own plan’s notice.
- Label documents for external review or the hearing.
- Keep dial-in details and request assistance early.
Keep personal, insurance and medical information in the appropriate organization’s approved secure channel.
Common questions
Does external medical review replace the state fair hearing?
No. HHSC describes it as an optional extra step before the hearing. The hearing remains available after that review unless the member withdraws the hearing request.
Can I add new information to the external medical review?
The independent review uses the internal-appeal record. Follow separate hearing instructions for additional facts or documents; the two processes have different evidence rules.
Sources: HHSC STAR Kids handbook: external medical review; Parkland STAR member appeals and state fair-hearing instructions
Sources and verification
The sources below support the administrative information in this guide. Follow the responsible organization’s current instructions when requirements, forms or contact routes change.